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Textbook of Public Health Dentistry
Third Edition
ss Hiremath MOS, FICO (USA)
Senior Professor and Head
Department of Public Health Dentistry
The Oxford Dental College and Hospital Bengaluru, India
Former Dean cum Director Government Dental College and Research Institute Bangalore, India
Dr RKBali BOS (Pb), MPH (USA), DSc (HC)
Dental Surgeon
Padmashree Awardee
Dr BC Roy National Awardee
Hony Dental Surgeon to the President of India
Past President: Dental Council of India
Diplomate: International Congress of Oral Implantologists, USA
Member (Overseas): Faculty ofGeneral Dental Practitioners, Royal College ofSurgeons, UK
President Emeritus, Indian Association of Public Health Dentistry
ChiefRegent, International College of Continuing Dental Education
Asia Pacific Dental Federation (AFDF/APRO)
Member: Dental Council of India
Doctor of Science, Chhatrapati Shaln�ji Maharaj Medical University
Foreword
I have a great pleasure in introducing and writing forward of this textbook.
A textbook covering awide spectrum oftopics in Public Health Dentistry is very much needed by the sludents and is valuable too. This speciality in dentistry encompasses several disciplines of General Public Health, Dental Public Health and Preventive dentistry, including Research methodology in keeping with the interest of the 1·caders and syllabus ofDental Council ofIndia. This textbook focuses on relevant topics ofPublic Health Dentistry.
The contributors have focused their attention on the basics and advanced aspects ofevery component ofthe practice of Public Health Dentistry. They have done full justice in providing authenticated and updated information of easy understanding. There is a much needed textbook of Public Health Dentistry for undergraduate studenls to provide a simplified version of the various components of the subject. I am sure it will be very useful and interesting to both teachers and students.
T haveknown Dr SS Fliremath fo1· more than two decades, in fact ever since he has been involved in active teaching. Dr Hiremath is a conunittcd and sincere amalgam of an inspiring teacher and above all a thorough gentleman. I strongly believe that he has done ample justice, along with other contributors, for this edition of the textbook.
I am sure this textbook has immense potential to become a standard and useful textbook for graduate and postgraduate students in India.
I congratulate Dr Hiremath and his good team of thecontributors for bringing out this beautiful publication.
DrRKBali
ShankarAradhya MOS
Professor and Head (ReLd)
Depanrnent of Public HealLh Dentistry
The Oxford Dental College, Bengalurn Fom1er President oflndian DentalAssociation of Public Health Dentistry
Dara SAmar Mo
Professor and Head (Retd) Department of Preventive and Community Medicine
StJohn's Medical ColJege, Bengaluru
Shivram Mu
Professor Emeritus Department of Community Medicine
Formerly, Principal
MS Ramaiah Medical College, Bengaluru
Prithvish 1\tl) DNI! l'GDH�IM F'ISHWM FAMS
Professor and HOD
Department of Community Medicine
InternationalExpert Consultant
Hea!Lh Care \.\laste Managemem, ,1/HO, SEARO
MS Ramaiah Medical College, Bengaluru
JayanthV Kumar oos MPH
State Dental Director
CaliforniaDepartment ofPublic Health
Chronic Disease Control Branch 1616, Capicol Avu, SACRAMENTO- CA, USA
Narendranath V MD
Professor and Head Department of Hospital Administration
MS Ramaiah Medical College
Chief Administrator
MS Ramaiah Mernor-ial Hospital, Bengaluru
Amit Chattopadhyay PhD, MJ'II, MOS, BOS (Hons), DIPJOURN, DcFM, MSASMS
Diplomate: America11 National Board of Public Health
Examiners
Diplomate: Amer-icanBoardofDentalPublic Health, Kolkata
KPushpanjali, M.os, Pco1111M, FAJMER FELLow 20:r3
Professor and Head
Department of Public Health Dentistry
Faculty of Dental Sciences
Chief - Quality Conu-ol (Academics)
MS Ramaiah Univer·sity of Applied Sciences, Bengaluru
Contributors
ManjunathP Puranik Mos
Professor and Head
Department of Public HeaIL11 Dentistry
Government Dental College and Research Institute, Bengaluru
BS Nanda Kumar MD, DNB, l'GUHHM
Head-Research and IPR
DivisionofResearch and Patents
AssociateProfessor- Community Medicine
MS Ramaiah Medical College and HospiLal, Bengaluru
Vijay Prakash Mathur MJJS
Additional Professor
Pedodontics andPreventive Dentistry
Centre for Dental Education and Research
WHOCollaboratingcentre for Oral HealLh Promotion
National Ceno-e ofExcellence for Implementation of National Oral Health Programme
All India Institute of Medical Sciences,New Delhi
Archana Krishna Murthy Mos
Professor
Department of Public Health Demistry
The Oxford Dental CoUege and Hospital, Bengaluru
Shivraj Msc
Assist.ant Professor
Department of Community Medicine (Epidemiology)
MS Ramaiah Medical College and Hospital, Bengaluru
Astha Singha!, Bos, MPH, PhD
Assistant Professor
Deparbnent of Health Policy and Health Services Research
Boston University Henry M. Goldman School ofDental Medicine
560 Hanison Ave. #342 B0st0n, MA 02118k
Sushi Kadanakuppe Mos
A5sistant Professor
Deparunenc of Public Health Dentistry
VS Dental College and Hospital, Bengaluru
Consultant, Life Skills Education and Peer Education
Ministry ofYouth Affairs and Sports, RCNIYD
Government of India, Sriperumbudur
Ramya R Iyer Mus
Reader
Department of Public Health Dentistry
KM Shah Dental College and Hospital, Vadodara
Measurement of a disease helps in quantification and also enables comparisons with other populations and over time. The chapter on Indices has been meticulously reviewed considering the properties, purposes and objectives of indices in general followed by detailed discussion on most commonly used indices in oral epidemiology.
Traditionally, payment has been fee for service two party system. The chapter on Financing Dent.al Care has been revised systematically. It deals with structure of dental practice followed by various methods of financing dental care. Payment in Indian scenario is also reviewed.
Dental needs and resources play a vital role in planning oral health programme. The chapter on Dental Needs and Resources discusses Bradshaw's concept of needs, types ofneed, demand for u-eatment, manpower and scope or service thatcan be rendered.
School health service forms a priority service in most of the couno-ies. However oral health is oft.en overlooked in developing countries. The chapter on School Dental Health Programmes deals with different aspects of school dental health programs, with emphasis on school-based preventive programs, health promoting schools and evaluation of such programs.
Practice of dentistrynotonly needs technical skills but also administrative skills. One should be aware of law ofland that regulates dental practice. Similarly duties and obligations towards patients, colleagues and community should be inculcated during the training period. Chapter on Dental Practice Management includes conceptof dental ergonomics. Similarly the chapters on Ethics in Dentistry, Dentist Act, DCI and IDA, and Consumer Protection Act have been updated comprehensively.
Dental examination hasbeencritical determinant in the search of identity of individual human remains. The chapter on Forensic Odontology deals with forensic (legal) aspect of dentisu, a-acing the history and highlighting the p1inciples and methods of dental identification with relevant description.
Part 3deals with preventive dentistry, an important tool of public healt11. Introduction to Preventive Dentistry provides concepts and principles and scope of preventive dentistry.
A chapter onDental Caries deals with aetiology, theories and concepts, types ofcaries, role of microbesand saliva in caries process. However, most of theevidence points towards roleofdiet (refined carbohydrates). Hence diet and dental ca,ies has been dealt in rletail linking diet. and dental caries, sugars and sugarsubstitutes and dietary counseling. Variousmethods have been developed to assess caries 1isk and caries activity. The chapter on CariesRisk assessment has been updated with relevant caries risk assessment tools which helps in identifying patients at risk and manage appropriately. The scopeandprospects ofdevelopingcariesvaccine has beenexploredinthe chapter on CariesVaccine.
Fluoride hasbeen cornerstoneof Preventive Dentistry since 1940s. Systemicandtopical fluorideshave been effective in reducing the incidence of dental caries. The chapter on Fluorides provides insight into various aspects of Fluorides including dent.al fluorosis and delluoridation whereas A Global Perspective on Application of Fluoride Technology givescurrentglobal scenariooffluoridesconsideringvarioussystemicandtopicalfluoridesandimportanceondeveloping policy on fluoride.
Newer methods and techniques are incorporated in the discipline of preventive dentistry. Minimal Intervention Dentistry hasrevolutionalisedthe management ofdentalcaries. Pitand Fissure Sealants, Preventive ResinRestoration, Minimal Invasive Dentistry have changed our outlook, and proceduresare more biological. Similarly, developmentof AtraumaticRestorative Treatment (ART) has provedtobe a boon indeveloping andunderdeveloped countries inthe managemem of dental caries. especially fordisadvantaged populations. Recent advances in concepts and approaches are added as required.
Creek historian Erasmus has stated 'Prevention is better than cure' and also a saying goes "an ow1ce of prevention is better than pound of treatment". Separate chapters on Prevention of Dental Caries, Periodontal Disease, Dental Trauma and Malocclusion give an account of different methods and approaches available for prevention of these diseases. Prevention ofDental Caries has been meticulously revised with a practical perspective.
Occupational Hazards in Dentist,)' deal with different types of hazards and their management. The chapter on Infection Conu-ol in Dental Care Setting is revised highlighting about the importance of infection control and guidelines to control.
Part 4provides insight into research methodology and biostatistics. Different types of design, ethical consideration, presentation, analysis and interpretation ordata are discussed.
Appendices includeuseful definitions andglossary, casehistory proforma,WHO oralhealth assessmentforms (1997 and 2013), facts and figures on fluoride and tobacco and other useful information.
Someofthe topicscontributedby highly experienced colleagues from other dentalinstitutions bring greater depth to the subject. This book deliberately takes a broader perspective ofPublic Health Dentistry.
1 am quite confident and sincerely hope this book will continue to serve like a useful textnot only for undergraduates, interns, postgraduates but also for dental public health professionals for whom it is intended.
SS Hiremath
Preface to the First Edition
Preventive and Community Dentistry forms the cornerstone ofdental education and oral health promotion. A need was felt sincelong for acomprehensive book which can provide abroad perspective on the challenges in the delivery of oral health care to the community and i.n planning appropriate strategies to meet those challenges. This book attempts to fulfill this need.
Based on the syllabus prescribed by Dental Council oflnclia, the book covers various aspects ofpublic health, dentalpublichealth, preventive dentisu-yand researchmethodology. It discusses all the topics ina systematic andlogical manner and alsohighlights the changingconcepts and contemporary issues in the field. In particular, the discussion ofDentalcariesandFluoridesin preventivedentistI)'isquite exhaustiveandalsoincludestherelevantrecentadvances and innovations. Suitable tables, flowcharts, diagrams and photographs are included throughout the book for an easier understanding ofthe subject.
An important feature ofthe book is the inclusion of additional chapters on Forensic dentistry, Hospital administration, Occupational hazards, Nutrition and oral health, Minimal intervention dentistry and Dental practice management. These chapters are vital for a richer understanding ofcon1munity dentistq,and I sincerely hope that both students and teachers find them equally useful.
Further, some useful information like facts about tobacco, Ouorides and clinical case profom1a are included separately under the Appendices. All these features make the book quite comprehensive in scope and contemporary in approach.
Prevention ofdental diseases is possible, but a great deal has to be done to achieve it. For this goal to become a reality, a rigorous implementation ofthe preventive dentistry is a must. Therefore, the role ofpreventive dentistry is crucial for sound oral health. Keeping this in mind, a sincere effort has been made in this book to cover the whole spectrum ofpreventive practice at both individual andcommunity levels.
Several practitioners and academics have contributed to this book. They areallexpertsin their respective areas and havee,m1estlystriven toproduce astimulatingand up-to-dateaccount ofthebasicconceptsin communityand preventive dentistry.
I sincerely hope that this book serves as a useful text to undergraduate students, interns, postgraduate and health professionals in preventive and community dentistry. I also hope that I have lived up to the words of Amos Bronson Alcot, "That is a good book which is opened with expectations, and closed with delight and profit."
Acknowledgements
At the outset, I would like to express my gratitude to a lot of people without ,vhosc involvement (in this venture), my bookwould not havebeen available now.
Two very distinguished academic personalities viz Dr BK Venkataraman, formerly Principal Government Dental College, Bengaluru and Dr SRamanand Shetty, Hon'bleVice-Chancellor, R�jiv Gandhi UniversityofHealth Sciences, Karnataka showed their lovinginterestinmy academic career. J expressmygratitude to both ofthemwhile Iprepare the present work for publication.
I mention with love the encouragemem of Dr RK Bali, the Fom1er President, Dental Council of India and the PresidentEmiratesoflndianAssociation ofPublicHealthDentistryto mywork inthe field of Public Health Dentistry. I am immensely thankfulto him forwriting the nice foreword for this textbook.
And a fewdistinguished great teacherslike Dr Dara S Amar, Dr Shivaram, Dr MR Shankar Aradhyahave beenwith me to give useful suggestions and guidance while the project was through deserve my sincere thanks. My sincere gratitude to Dr Pruthvish, DrJayant Kumar, Dr Amit Chattopadhyay, Dr Narendemath, Dr A�tha, Dr Nanda Kumar, Dr Shivraj, Dr Vijaya Prakash Mathur and Dr Vartika Kathuria Monga, join the above contributors to make the book verily academic.
Iamprivilegedtohaveathoroughco-operationandunderstandingfom DrMaajunathPuranik, and Dr Pushpanjali whojoined my pr�ject of this book writing so willingly fom the beginning of first edition of this book. They remained a strong source of moral support to me throughout the development of project. l must express my heartfelt thanks to them.
My work depended on making available the suitable source material on various details of subjects and updating whichwas undertakenby DrRamya and Dr Sushi.They did thisjob sohappily and gave me unconditional support for my project. They must be warmly congratulated and thanked.
Editing and reviewing of a work is painstaking; a great responsibility too. Dr Anitha, Dr Archana, Dr Sowmya, Dr Priyadarshini, Or Sakeena, Dr Shilpasree, Dr Shabana, Or Shwetha, Dr Renuka Piddennavar and Dr Randheer showed great patience in helping me to properly manage thetask on hand. A heartfelt thanks to all of them.
At the same time I wish to recognise and appreciate the support extended by postgraduate students Dr Sonali, DrAnkita, Dr Madhushree, DrMalavika, DrVaibhavGupta and Dr Sneha Shenoy. My specialthanksare duetothem.
Reviewing and updating material in the growing field like Dental science is challenging to keep track. Dr Naveen, Dr Fareed, and DrJagannath made my work more authentic. Heartythanks to all of them.
Atthisjtmcttu-eI shouldnecessarilyrecallthe staffco-operationfromtheDepartrnentofPreventiveandCommunity Dentistry, Government Dental College and Research Institute, Bengaluru. Especially, Dr Yashoda R Dr Namitha Shanbhag, Dr Uma SR, and Postgraduate students Dr Shailee and Dr Ashwini Biradar who all provided continuous support to my previous work. My grateful thanks to all of them.
A great senseofappreciationandthanksoverwhelms mewhenI remember DrGurmukh and Dr Kevin PG student, for their unstinted support and help rendered during the preparation of the manuscript.
I wish to remember the academic support of Dr Manjunath R, Dr Sadanand, Dr Manjunath C, Dr Sangeetha and Dr Utkal whose participationin preparing the earlier text was a labour of love. My thanks are due to them.
I wish to congratulate and thank the dynamic publisher, RELX India Pvt. Ltd. for associating with my academic activity. In this connection, least I would not forget, I must place on record the services of Ms Nimisha Gos,Nami, Manager-Content Strategist, Mr Anand Jha, Prqject Manager-Medicine and Dentistry, and Goldy Bhatnagar, Sr Content Development Specialist, for their wonderful coordination while editing the manuscript of the book. Sincere thanks and great appreciations to all of them.
From the family Dr RS Hiremath, my eldest brother deserves a special mention when my book will be ready forpublication. Itis withreverence andabsolutelove, I remember Dr RS Hiremathfor makingmeachieve so much in life.
Speaking of myfamily, Umadevi my wife and children Dr Suman Bharat Kumar (USA) and Mr Gurudev Hiremath (USA) must be mentioned particularly because their love and tot.al support to me while I was engaging myseu·in this stupendous task of wiiting the book were unique. They deserve my special thanks.
Itisone occasion thatcallsfor expressing my deepest feelings ofrespectto allthose professional colleagues, friends andotherwell-wisherswho at severalstages of myworkencouraged and gavesuggestions to me and thatwas my good fortune. Hence, all such persons must be thanked at this moment. My sincere thanks to allof them, a dutyonmypart.
Motivation to my work happens to be the almighty god whose kindness was my experience throughout the pr�ject. For such a shower ofblessings from the unique force, I remain devoted.
7 International and Notional Health Agencies, 80 Hiremath SS I Anitha R Sagorkor lnLroduction, 80 Objectives, 80 Quarantine, 80 InternationalHealthAgencies, 81 IndianVoluntaryHealthAgencies, 84
8 Hospital Administration, 88 NorendronathV Introduction, 88 ChangeofRoleasHealthAdministrator, 88 ImportanceofHospitalAdministration, 88 ImportanceofHospital Management, 88 HospitalasaSystem, 89 LegalAspectsofPrivatePractice, 90 QualityinDentalPracticeandAccreditation, 90 NABHStandardsforDentalFacility, 91
9 Behavioural Sciences, 93
Daro SAmar I Sushi Kodanokuppe Inu·oduction, 93 Definition, 93 Componems, 93 CategoriesofBehaviouralSciences, 93 ScopeandUseofBehaviouralScienceinDental Health, 93 Sociology, 94 Psychology, 94 SocialPsychology, 96 Conclusion, 97 Anthropology, 97
DENTAL PUBLICHEALTH
10 Introduction to Dental Public Health, 103
Monjunath PPuranik lnU"oduction, 103 1-UstoryofDentisu11 , l03 PlanningDentalCare, 105 ScopeofDentalCare, 105 PublicHealth, 105 DentalPublicHealth, 107 FuncHonsofPublicHealthDentist, 108
RolesofDental Public HealthWorkers, 109 AchievementsofDentalPublicHealth Professional, 109
11 Epidemiology of Dental Caries, 111
Hiremath SS I Sushi Kadanokuppe Introduction, 111 EpidemiologicalStudies, 111 IndianScenario, 112 GlobalScenarioandCurrentTrendsinCaries Incidence, 112
Epidemiological FactorsofDental cai;es, 113 I.HostFactors (DemographicFactors), 113 11 AgentFactors, 115 IIT.Environmental Factors, 115
12 Epidemiology of Periodontal Diseases, l l8
Hiremath SS
Introduction, 118
EpidemiologyofPeriodontalDisease, 118
EpidemiologicSLudies, 118
NationalOralHealthSurveyand FluorideMapping 2002-2003 (ConductedbyDentalCouncilof India), 119
AetiologyofPeriodontalDisease, 120 PathogenesisofPeriodontalDisease, 122 EpidemiologicFactors, 123
13 Epidemiology ofOral Cancer, 126
Hiremath SS
Inu·oduction, 126
GlobalScenarioofOralCancer, 126 SpectrumofOralCancerinIndia, 127 EpidemiologicalStudies, 127
AgeDistribution, 128 GenderDistribution, 128
EthnicBasis, 128 SiteDistribution, 128 Trends, 128
AetiologyandRiskFactors, 128 ClassificationofOralCancer, 130
Clinical Presentationsof CancerofOral Mucosa, 132 DiagnosisofOralCancer, 132 TreatmentofOralCancer, 133 PreventionandControlofOralCancer, 133 RoleofDentistinDetectingandPreventing Oral Cancer, 136
Population-BasedCancerRegistries: InvisibleKeyto CancerControl, 136
14 Oral Health Education, 139 ManjunothPPuronik Introduction, 139 ConsiderationsinOralHealthEducation, 139 NatureofLeaming, 140 EducaLionalProcess, 140 Communication, 141 GeneralEducationalTheories, 142 BasicConceptsofOralHealthEducation, 143 ApproachesinOralHealthEducationandHealth Promotion, 145
15 Nutrition and Oral Health, 147 Pushpanjali K I Ranadheer R Inu·oduction, 147 Nuu·ition, 147 ClassificationofNutrients, 147 RecommendedDietaryAllowances, 151 AssessmentofPatient'sNutritionalStatus, 151 DietaryHistory andEvaluation, 151 DietCounsellingandDietaryAdvice, 152
16 Surveying and Oral Health Surveys, 155 ManjunathP Puronik
Surveying, 155 Int.roduction, 155 Steps inSurvey, 155
Oral Health Surveys, 158
PathfinderSurveys, 158 Subgroups, 158
IndexAgesandAgeGroups, 158 NumberofSubjects, 159 OrganizingtheSurvey, 159 ReliabilityandValidityofData, 160 ImplementingtheSurvey, 160 Sun•eyForm, 160
17 Indices, 162
Hiremath SS I Arehano Krishnamurthy Inu-oduction, 162 DefinitionofIndex, 162 Objectiveofan Index, 162 PropertiesofanIdealIndex, 162 PurposeandUsesofanIndex, 163 SelectionofanIndex, 163 TypesofIndices, 163
18 DentalAuxiliaries, 184
Hiremath SS Introduction, 184
RationaleforTrainingandUseofDental Auxiliary, 184 Definition, 184 Classification, 185 EffectsofAuxiliariesonDentalEducation, 186 interestingtoKnow, 187
DentalManpowerPlanning, 187 BenefitsofUsingAuxiliaries, 188 ImpactofAuxiliariesinIndianScenario, 188
19 FinancingDentalCare, 190
Manjunath P Puranik
Introduction, 190
SuuctureofDentalPractice, 190 JnsuranceandDentalCare, 191 ClassificationofPaymentPlans, 192 PublicFinancingofHealthCare, 195 StateChildren'sHealthInsuranceProgramme (Schip), 196 IndianScenario, 196
20 DentalNeedsandResources, 199
Manjunath P Puranik lnu-ocluction, 199 DentalNeeds, 199 DemandforTreatment, 200 Manpower, 201 ScopeofService, 201 MatchingProgrammescoNeedandDemand, 201
21 PlanningandEvaluationinOralHealth, 203
Manjunath P Puranik
Introduction, 203
TypesofHealthPlanning, 203
PlanningofDental HealthServices, 203 PlanningforCommunityDentalProgrammes, 205
Rational PlanningModel, 207 Evaluation, 207
22 SchoolDentalHealthProgrammes, 210 Hiremath SS
Introduction, 210 Health PromotingSchool, 210 ImportanceofOral HealthinChildren, 210 ImportanceofSchoolsinPromotingOral Health, 211
PlanningaSchoolDentalHealthProgranune, 211 OralHealthEducationProgrammes, 213 SchoolBasedPreventiveProgrammes, 215 ReferralforDentalCare, 216 School Lunch Programme, 216 IncrementalDentalCare, 217 Evaluation, 217
23 DentalPracticeManagement, 219 Shankor Arodhya MR I Shilpashree KB Introduction, 219 FactorsAssociatedwithSuccessfulDeneal Practice, 219
24 EthicsinDentistry, 224 Manjunath P Puranik Introduction, 224 Ethicsand HumanConduct, 224 EthicsandSocialSciences, 224 EvolutionofMedical Ethics, 225 BasisforMedicalEthics, 225 PrincipiesofEthics, 225 EthicalRulesforDentistsinIndia, 226
25 DentistAct-1948, 228
Manjunath P Puranik lnD'oduction, 228 Effect ofRegistration, 231 Miscellaneous, 231 TheDentists (Amendment)Act,1993, 233
26 DentalCouncilofIndia(DCI)andIndian DentalAssociation(IDA), 236
Hiremoth SS I Sowmya KR Dental Council of India, 236 lnD'oduction, 236 Defmitions, 236 ConstitutionoftheCouncil, 237 ModeofElections, 237 TheExecutive Committee, 237 RecognitionofDentalQualification, 237 QualificationofDentalHygienists, 238 QualificationofDentalMechanics, 238 PreparationandMaintenanceofRegister, 238 TheIndianDenealAssociation (IDA), 238 ManagementoftheAssociation, 239
27 ConsumerProtectionAct, 241
Hiremoth SS I Sowmya KR Introduction, 241 SupremeCourtDecisionsoftheConsumerProtection Act, 242 Definitions, 242 ConsumerRedressalForumsandCommissions, 242
Authorities for Filing Complaints Based on Amounts ofCompensation, 243 Powers ofConsumer Redressal Forumsand Commissions, 243
Vlho Can Suethe Doctor UnderCPA?, 243 Against \,\Thom Cana Complaint be Filed?, 243 WhoareExempted?, 244 WhatShouldYou Do\!\'henYou Receivea Complaint?, 244
What is a Complaint?, 244 Time Limit to File a Complaint, 244 Guidelines to beAdopted toAvoid Needless Litigations, 245 Consent, 245
Sa.lient Features ofConsumer Courts, 246 Consumer Protection Act and Patients, 246 Consumer Protection Act and Doctors, 246 Limitation of Consumer Forum, 246
28 Forensic Odontology, 248 Pushponjoli K
Jnu·oduction, 248 History, 249
Common Reasons for Identification ofFound Human Remains, 249 Principles ofDental Identification, 250
29 Introduction and Principles of Preventive Dentistry, 261 Hiremoth SS
Concepts ofPreventive Dentistry, 263 Scope ofPreventive Dentisny, 263 Principles ofPreventive DentisLry, 263
30 Dental Caries, 265 Hiremath SS I Sushi Kadonakuppe
Introduction, 265
EarlyTheories ofCariesAetiology, 266 CurrentConcepts ofCa1ies Aetiology, 267 Microbiology ofDental Caries, 268 MechanismofAdherenceofMicroorganisms toTooth Surface, 269
Formation ofPlaque, 269 Role ofSaliva in Dental Caries, 269 Classification ofDental Caries, 270
Clinical Manifestations ofDental Caries Process, t73 Caries of Enamel, 274
Dentinal Caries, 276 Root Caries, 276
31 Diet and Dental Caries, 278
Hiremath SS
Introduction, 278
Food, 278
Diet, 278
Nutrition, 278
Components ofFoods, 278
Classification ofCarhohydrates, 278
Evidence Linking Diet and Dental Caries, 279 CariogenicityofSucrose, 280
Stephan Curve (1940), 281
Oral Clearance ofCarbohydrates I, 281
Preventive Dietary Programme, 282
Dietary Counselling, 282
Tooth-Friendly Snack or Ideal Snack, 283
Sugar Substitutes, 283 Functions ofSugar in Food Technology, 283 ClassificaLion, 283
Difficulties in Substitution ofSucrose, 284
32 Caries Risk Assessment, 285
Hiremoth SS I Archono Krishnomurthy lntroduction, 285
Risk Group, 285
Factors RelevantforAssessment ofCaries Risk, 286 Clinical Evidence, 287
IdentifyingRelevant RiskFactors, 287 Caries Risk AssessmentTools, 287 Caries Diagnosis an<l Lesion Detection, 288
33 Caries Activity Tests, 290 Hiremath SS
Introduction, 290 Caries Activity Tests, 290 Mutans Group ofStreptococci ScreeningTests, 292 Uses, 293
34 Cariograrn, 294
Hiremath SS
Cariogram-The Five Sectors, 294 "ChancetoAvoidCaries", 295 PrinciplesofCaries Risk Estimation Based on "Cariogram" Concept, 295 Usingthe CaiiogTam for Evaluation ofCa1ies Risk, 298
35 Dental Caries Vaccine, 300
Hiremath SS lntroduction, 300 Prospects forVaccination Against Dental Caries, 301 RouteofAdminis1..-ation ofVaccine, 301 EffectiveMolecularTargets forDentalCm·ies Vaccine, 302 Synthetic Peptide Vaccines, 302 Risk Factors, 303 Past, Presentand Future Human Applications, 303
36 Fluorides, 306
Hiremath SS
Introduction, 306 Water Fluoridation, 306 Physiologyand Chemistry of Fluoride, 309 Fluo1ide Homeostasis, 309 Fluo1ide Bioma1·kers, 3L2 Mechanism ofAction ofFluoride, 313 ClassificationofFluorideTherapy, 315 Dental Fluorosis, 324 Defluo.idation, 326 Reports fom Who onAppropriate Use ofFluorides for Human Health, 328
PART
PUBLIC HEALTH
1. Concepts of Health and Disease and 6. National Health Programmes, 70 Prevention, 3
7. International and National Health
2. General Epidemiology, 17 Agencies, 80
3. Environmental Health, 34
4. Health Education, 57
5. Primary Health Care, 65
8. Hospital Administration, 88
9. Behavioural Sciences, 93
